Test 3 - Respiratory Dysfunction Flashcards

Question

Epiglottitis

Answer 1

Epiglottitis Sicker, drooling, and can kill you, you want to leave them alone - never stick anything in mouth or cause pain, dont stick a tongue blade, it would reflexively swell Get steroids Characterized by hoarseness, barking cough (sounds like a seal), inspiratory stridor, and varying degrees of respiratory distress Croup syndromes affect the larynx, trachea, and bronchi Epiglottitis, laryngitis, laryngotracheobronchitis (LTB), tracheitis

Answer 2

Acute Epiglottitis- A Medical Emergency Clinical manifestations Rapid progression Sore throat, pain, tripod positioning, retractions Inspiratory stridor, mild hypoxia, distress Watch for: absence of spontaneous cough, drooling, agitation/anxiety Therapeutic management Potential for respiratory obstruction Nursing considerations – do not attempt to inspect the throat! Keep child as calm as possible. Allow position of comfort Prevention requires Haemophilus influenzae type b (Hib) vaccine, incidence greatly decreased since vaccine

Answer 3

Acute Laryngotracheobronchitis (LTB) Most common croup syndrome Generally affects children younger than 5 years of age Organisms responsible RSV, parainfluenza virus, Mycoplasma pneumoniae, influenza A and B viruses Manifestations of LTB Inspiratory stridor Suprasternal retractions Barking or seal-like cough Increasing respiratory distress and hypoxia Can progress to respiratory acidosis, respiratory failure, and death Therapeutic Management of LTB Airway management Maintain hydration (oral or IV) High humidity with cool mist Nebulizer treatments Epinephrine (racemic) – rapid onset, peak effect at 2 hours Steroids

Answer 4

Considered the“reactive”portion of the lower respiratory tract Includes bronchi and bronchioles Cartilaginous support is not fully developed until adolescence Constriction of airways

Answer 5

``` Also known as tracheobronchitis Definitions – inflammation of the large airways Causative agents – primarily viral Clinical manifestations Dry hacking cough Worsens at night Mild, self-limiting disease ```

Answer 6

Definitions: common acute viral illness, maximum effect and the bronchiolar level Respiratory syncytial virus (RSV) : occurs cyclically in winter and spring Most common cause of hospitalization in <1 year of age Severe RSV at <1 y is a significant risk of developing asthma

Answer 7

Pathophysiology Affects the epithelial cells which swell and protrude into the lumen Lumina fill with mucus Leads to hyperinflation (they can breath out but can’t get the air out), hypoxia (bronchial with mucous not exchanging), atelectasis

Answer 8

Diagnostics Nasopharyngeal swab - you don’t want the mucous, you want the nasopharyngeal cell CXR: hyperinflation

Answer 9

Therapeutic management Most managed at home, Humidified O2, Periodic suctionin- especially before feedings, Fluids PO or IV, Bronchodilators? Prevention of RSV: prophylaxis (synagis), handwashing Nursing considerations: isolation, close monitoring, teach mom to provide care at home, suctioning

Answer 10

Inflammation of the pulmonary parenchyma Causative organism varies greatly by age category The most useful classification is etiologic agent: Viral, Bacterial, Mycoplasma, Aspiration of foreign substances Clinical Manifestations Vary depending on Age, Etiology, Systemic reaction to infection, Extent of the lesions, Degree of obstruction

Answer 11

Pertussis (Whooping Cough) Caused by Bordetella pertussis Highly contagious In the United States, it occurs most often in children who have not been immunized Highest incidence is in spring and summer Hallmark: severe, paroxysmal coughing, followed by characteristic “whoop”, Young infants may present with apnea - Heart rate will drop, stats will drop Post-tussive emesis common, often vomit afterwards Three phases Catarrhal - Increase secretion, running nose and eyes, look like any type of cold Paroxysmal - last a long time Convalescent -

Answer 12

Asthma Chronic inflammatory disorder of the airways Recurring episodic symptoms Wheezing, Breathlessness, Chest tightness, Cough (especially at night) Limited air flow or obstruction that reverses spontaneously or with treatment Bronchial hyper responsiveness Narrowed airways causes forced expiration. Air trapping Reduced alveolar air exchange Inflammation now recognized as playing a key role in asthma

Answer 13

Step I: Intermittent asthma Sx <2 days/week, no limitations on ADL Step II: Mild, persistent asthma Sx > 2x/wk but not daily, night time 1-2x/mo, some limitations to ADLs Step III: Moderate, persistent asthma Daily symptoms, freq night sx, minor limitations to ADLs Step IV: Severe, persistent asthma Continued daytime sx, freq night sx, use of relievers several times per day, extreme limitations on ADL

Answer 14

``` Diagnostic evaluation Dyspnea, wheeze, cough PFTs, PEFR, allergy testing Therapeutic management Pharmacologic therapy Nonpharmacologic therapy Allergen/trigger control ```

Answer 15

Nursing considerations Importance of patient and family teaching Need to control triggers in hospital Smoking cessation

Answer 16

Drug Therapy for Asthma Long-term control medications Preventive (Controller) DAILY use, even when feeling well Quick relief medications Rescue (Reliever) - albuterol, xopenex Metered-dose inhaler (MDI) Always use with spacer/mask Corticosteroids - First line treatment Significant improvement of all asthma parameters Albuterol, terbutaline Β Adrenergic agonist, rapid onset treatment for acute bronchospasm ``` Dilates bronchioles prevent EIB (exercise-induced bronchospasm) - exercise induced ``` Long-term bronchodilators (salmeterol [Serevent]) Not used in children <12 years Theophylline (monitor serum levels) rarely used, causings significant agitation, and tachycardia, if serum too high pt vomits only in ED when not responding to maximal therapy ``` Leukotriene modifiers (singulair) Mediates inflammation, given in combination with β agonist, steroids for long term control ```

Answer 17

Asthma Intervention Exercise/play Evaluate for EIB (exercise induced bronchospasm) Chest physical therapy (CPT) Breathing exercises - encourage cough and deep breathing

Answer 18

Status Asthmaticus Respiratory distress continues despite vigorous therapeutic measures Sweating, remains sitting upright, refusal to lie down, agitation, absence of breath sounds, only speaking a few words at a time, level of conciousness is deminishing (meaning not enough air is getting in)= immediate intervention Emergency treatment is epinephrine 0.01 mL/kg subcutaneously (maximum dose, 0.3 mL) Magnesium sulfate - infuse over 20 minutes usually Potent muscle relaxant, decreases inflammation Monitor for side effects, can cause severe hypotension Vital signs q10minutes for an hour Concurrent infection in some cases - pt may also have pneumonia, thus start pt on antivirals

Answer 19

Acute Asthma Care Calm nursing presence - pt and family might get anxious seeing you etc. Auscultation of breath sounds, air movement Monitor with pulse oximetry Titrate O2 - Choice of O2 delivery devices Allow older children to sit up if they are more comfortable in that position Allow parents to remain with children Oral vs IV fluids

Answer 20

Goals of Asthma Management Avoid exacerbation, Avoid allergens Relieve asthmatic episodes promptly, Relieve bronchospasm Monitor function with a peak flow meter Self-management of inhalers, devices, and activity regulation Support child, adolescent, and family Identifying Asthma Triggers Viral infection, Exercise, Perfumes, Smoke One of the most important components of decreasing episodes of exacerbations Differs in each person - was there a weather change, different setting, food, etc Common triggers (not an exhaustive list) Viral infections (most common trigger for infants) “he never gets these symptoms unless he has cold, Perfumes, strong odors Smoke: tobacco, marijuana, wood, BBQ, fires, Exercise, Changes in temperature, Animal dander - cats.dog, Dust and mold, Pollen, Food allergies

Answer 21

Cystic Fibrosis (CF) Exocrine gland dysfunction that produces multisystem involvement Most common lethal genetic illness among Caucasian children Autosomal recessive trait - need a defective gene from both parents Child inherits a defective gene from both parents, with an overall incidence of 1:4 Approximately 3% of the U.S. Caucasian population are symptom-free carriers

Answer 22

Pathophysiology of CF Predominantly affects the respiratory tract and the pancreas - produce cement like mucous Increased viscosity of mucous gland secretions Responsible for many of the clinical manifestations Elevation of sweat electrolytes Increase in several organic and enzymatic constituents of saliva Increase in sodium and chloride in saliva and sweat Exocrine Gland Dysfunction in CF

Answer 23

Clinical Manifestations of CF Pancreatic enzyme deficiency - doesnt let them digest fat Progressive chronic obstructive pulmonary disease (COPD) associated with infection Sweat gland dysfunction Failure to thrive - due to fighting all infection, they’re not absorbing food Increased weight loss despite increased appetite Gradual respiratory deterioration

Answer 24

Presentation of CF Wheezing respiration; dry, nonproductive cough, Generalized obstructive emphysema Patchy atelectasis, Cyanosis Clubbing of fingers and toes Repeated bouts of bronchitis and pneumonia Seem like “sickly baby” - aren’t gaining weight, are sick often Meconium ileus - Earliest recognizable manifestation of CF Prolapse of the rectum - due to the stool Distal intestinal obstruction syndrome Excretion of undigested (fat) food in stool - Stool is bulky, frothy, and foul smelling Wasting of tissues (not absorbing fat, thus not absorning vitamin A,D,E,K (fat soluble)) Delayed puberty in females Sterility in males Parents report that children taste “salty” - when kissing their child Dehydration, Hyponatremic or hypochloremic alkalosis, Hypoalbuminemia

Answer 25

``` Diagnostic Evaluation of CF Quantitative sweat chloride test - make them sweat and test the sweat Chest x-ray Pulmonary function tests (PFTs) Stool fat and/or enzyme analysis Barium enema ```

Answer 26

Treatment Goals for CF Prevent or minimize pulmonary complications, Adequate nutrition for growth, Assist the child in adapting to a chronic illness

Answer 27

Respiratory Manifestations of CF Present in almost all CF patients, but the onset and extent vary Viscous secretions are difficult to expectorate and obstruct bronchi and bronchioles Cause atelectasis and hyperinflation Stagnant mucus leads to destruction of lung tissue Stagnant mucus provides a favorable environment for bacteria growth

Answer 28

Respiratory Progression Gradual progression follows chronic infection Bronchial epithelium is destroyed Infection spreads to peribronchial tissues, weakening the bronchial walls Peribronchial fibrosis Decreased exchange of O2 and CO2 - end up on oxygen all the time, kids become slim

Answer 29

``` Further Respiratory Progression Chronic hypoxemia causes contraction and hypertrophy of muscle fibers in pulmonary arteries and arterioles Pulmonary hypertension Cor pulmonale Pneumothorax Hemoptysis ```

Answer 30

Respiratory Management of CF CPT (chest physiotherapy) and postural drainage - Therapy vests - vibrate to help move the mucous Bronchodilator medication, Forced expiration Aggressive treatment of pulmonary infections Home IV antibiotic therapy, Aerosolized antibiotics Steroids or non-steroidal anti-inflammatory drugs (NSAIDs) Transplantation

Answer 31

Gastrointestinal (GI) Tract Thick secretions block ducts, leading to cystic dilation, degeneration, and diffuse fibrosis Prevents pancreatic enzymes from reaching the duodenum - have to take handful and pancreatic enzyme Impaired digestion and absorption of fat, or steatorrhea, occurs Impaired digestion and absorption of protein, or azotorrhea, develops Earliest manifestation may be meconium ileus Endocrine function of the pancreas is initially unchanged Eventually, pancreatic fibrosis - could kill off the pancreas occurs; may result in diabetes mellitus Focal biliary obstruction results in multilobular biliary cirrhosis - may cause heart, liver transplant Impaired salivation

Answer 32

GI Management in CF Replacement of pancreatic enzymes High-protein, high-calorie diet, as much as 150% of the recommended daily allowance (RDA) Treat constipation Reduction of rectal prolapse Salt supplementation Treat gastroesophageal reflux- Place the patient in the upright position after meals

Answer 33

Endocrine Management of CF | Monitor blood glucose levels, Diet, Exercise, Regular eye examinations

Answer 34

Prognosis of CF Estimated life expectancy for a child born with CF in 2008 was 37.4 years CF continues to be a progressive, incurable disease Organ transplantation has increased the survival rate Heart–lung and bilateral lung transplantation Liver and pancreas transplantation For lung transplants, the survival rate is 75% at 1 year and 55% at 3 years following transplantation. Maximize health potential Nutrition, Prevention and early aggressive treatment of infection, Pulmonary hygiene

Answer 35

Family Support for the Child with CF Coping with the emotional needs of the child and family Developmental care Child requires treatments multiple times each day Frequent hospitalizations Implications of genetic transmission of disease

Answer 36

Long-term control medications Preventive (Controller) DAILY use, even when feeling well Quick relief medications Rescue (Reliever) - albuterol, xopenex Metered-dose inhaler (MDI) Always use with spacer/mask

Answer 37

Corticosteroids - First line treatment | Significant improvement of all asthma parameters

Answer 38

Albuterol, terbutaline Β Adrenergic agonist, rapid onset treatment for acute bronchospasm ``` Dilates bronchioles prevent EIB (exercise-induced bronchospasm) - exercise induced ```

Answer 39

Long-term bronchodilators (salmeterol [Serevent]) Not used in children <12 years

Answer 40

Theophylline ***(monitor serum levels) rarely used, causings significant agitation, and tachycardia, if serum too high pt vomits only in ED when not responding to maximal therapy

Answer 41

``` Leukotriene modifiers (singulair) Mediates inflammation, given in combination with β agonist, steroids for long term control ```

Test 3 - Respiratory Dysfunction Flashcards

(65 cards)